·Patient transportation services claiming charges for patients who are not even moved to and from hospitals/home

One industry example mentioned in the reports: In one brash scheme, immigrants set up a network of fraudulent medical-supply stores in the Southwest, hoping to cheat Medicaid and Medicare. The gang hired recruiters to bring them innocent patients eligible for Medicaid or Medicare. They then paid off local doctors to prescribe motorized wheelchairs worth $7,500 but instead gave them motor scooters worth just $1,500, pocketing the difference. Investigators shut down the scheme after noticing billings for wheelchairs in Arizona, Texas, and other states scaling into the hundreds of millions of dollars.

How analytics can help in Fraud detection/prevention:

·Detecting the patterns of fraud in the bills provided by doctors, hospitals, nurses

·Profile & segment claimants to identify those who are likely to commit fraud